Workers Compensation Claims Supervisor

Job DetailsLevel: ManagementJob Location: Fresno Office - Fresno, CA 93727Position Type: Full TimeEducation Level: High School Diploma or GEDSalary Range: $110,000.00 - $110,000.00 Salary/yearTravel Percentage: NegligibleJob Shift: DayJob Category: InsurancePOSITION SUMMARY:  This position requires considerable interaction with the client, management, other Claims Examiners, and other TRISTAR staff in the office; therefore, consistently beginning work, in a timely manner, is inherently required of this position.

 

DUTIES AND RESPONSIBILITIES:


Directly supervise examiners and clerical staff. Includes monitoring attendance, job performance, evaluations, and disciplinary issues. *
Reviews and addresses scheduled claims issues, such as initial and periodic reviews, delays, denials, etc.*
Reviews and approves reserve changes, awards, and payments within Company and Client guidelines. *
Performs file reviews to monitor compliance with policies and laws. *
Establishes appropriate supervisory diaries on claim files and completes pending diaries on or before scheduled due dates. *
Prepares for claim audits, reviews audit results, and provides appropriate rebuttal feedback. *
Coordinates and leads training sessions for staff on updated laws, policies, and procedures. *
Ensures daily caseload staffing requirements are met. *
Responds to claimant and vendor concerns and issues as needed. *
Ensure client handling instructions are being adhered to. *
Analyzes monthly client reports.*
Facilitates internal and external audits.*
Attends client file-staffing meetings in-person or telephonically.*
Other duties as assigned.


*Essential job function.

 

 

EQUIPMENT OPERATED/USED:  Computer, 10-key, printer, copier, fax machine and other office equipment.

 

SPECIAL EQUIPMENT OR CLOTHING:  Appropriate office attire.
QualificationsQUALIFICATIONS REQUIRED:

Education/Experience: Bachelor’s degree in related field (preferred); three (3) to five (5) years related experience; or equivalent combination of education and experience.

 

Knowledge, Skills and Abilities:


Technical knowledge of statutory regulations.
Ability to work on a diary system, prioritize tasks and meet strict deadlines.
Strong analytical skills.
Proficient in Word and Excel.
Excellent written and verbal communication skills, including ability to convey technical details to claimants, clients, and staff.
Ability to manage employees of various skill levels.
Excellent interpersonal skills.


 

Other Qualifications:


Certifications and/or licenses as required by State regulation.


 

Mental and Physical Requirements: [see separate attachments attached for a copy of checklist of mental and physical requirements]

 

 





MENTAL AND PHYSICAL REQUIREMENTS





MENTAL EFFORT


 


Reasoning development:


Solve practical problems; variety of variables with limited standardization; interpret instructions.
Logical or scientific thinking to solve problems; several abstract and concrete variables.




 





Mathematical development:

Add, subtract, multiply, and divide whole numbers.
Arithmetic calculations involving fractions, decimals, and percentages.




 





Language development:

Ability to compose original correspondence, follow technical manuals, and have increased communication with people in person or on the phone. 
Ability to evaluate technical data.
Ability to interview job applicants.
Ability to give directions, provide advice and feedback, and reprimand as necessary.




 





 PHYSICAL EFFORT


 


Physical activity required to perform the job:


Light work:


Exerting up to 20 pounds or force occasionally.
Exerting up to 10 pounds frequently.
Exerting a negligible amount of force constantly to move light objects.
Frequently sitting, standing, and walking.


 





Visual requirement necessary to perform the job:



Near vision: clarity of vision at 20 inches or less.
Mid-range vision: Clarity of vision at distances of more than 20 inches and less than 20 feet


 





 PHYSICAL EFFORT (cont.)



FREQUENCY





Physical activity necessary to perform the job and frequency (e.g., continually, frequently, or occasionally):


 


 

 




Crouching:   Crouching: Bending the body downward and forward by bending legs and spine. 

 


Occasionally




Stooping:  Stooping:  Bending body downward and forward by bending spine at the waist.  This factor is important if it o